1. MOTHER DR. MRS. MS. FULL NAME HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL OCCUPATION TITLE EMPLOYER FATHER DR. MR. FIRST NAME LAST NAME MIDDLE NAME MALE FEMALE EdChoice 2016-2017 School Year Required for Kindergarten - Grade 8 Please submit form with application fee APPLICANT (STUDENT) INFORMATION DATE OF BIRTH (MM/DD/YYYY)GRADE LEVEL FOR 2016-17 FAMILY INFORMATION APPLICATION FOR REGISTRATION & ENROLLMENT AGREEMENT SAINT JOSEPH SCHOOL A Higher Standard All information must be completely filled-in before accepted NICKNAME (IF PREFERRED) FULL NAME HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL OCCUPATION TITLE EMPLOYER PARENTS ARE MARRIED AND LIVING TOGETHER PARENTS ARE SEPARATED MOTHER IS REMARRIED NAME OF STEPFATHER PARENTS ARE DIVORCED SINGLE PARENT FATHER IS REMARRIED NAME OF STEPMOTHER GUARDIAN (if applicable) FULL NAME RELATIONSHIP TO APPLICANT HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL RETURNING STUDENT NEW STUDENT WITH WHOM DOES THE STUDENT PRIMARILY RESIDE? (CHECK ALL THAT APPLY) MOTHER FATHERLEGAL GUARDIAN OTHER (PLEASE EXPLAIN ) HOME STREET CITY STATE ZIP RACE / ETHNICITY: AFRICAN AMERICAN/BLACK ASIAN AMERICAN CAUCASIAN/WHITE LATINO/HISPANIC MULTIRACIAL NATIVE AMERICAN PACIFIC ISLANDER OTHER RELIGION: CATHOLICNON-CATHOLIC WILL THE STUDENT BE A BUS RIDER? YESNO WHAT PUBLIC SCHOOL BUILDING WOULD THE STUDENT ATTEND IF THEY WERE NOT ENROLLED AT SAINT JOSEPH SCHOOL (FOR EXAMPLE: NORD, POWERS, ETC.)? WHAT PUBLIC SCHOOL DISTRICT WOULD THE STUDENT ATTEND IF THEY WERE NOT ENROLLED AT SAINT JOSEPH SCHOOL? HOW DID YOU FIRST HEAR ABOUT SAINT JOSEPH SCHOOL AND WHAT LED TO YOUR DECISION TO CHOOSE SAINT JOSEPH SCHOOL AS THE PLACE OF EDUCATION FOR YOUR CHILDREN? REFFERAL: * *a copy of the divorce decree pertaining to the child must be on file in the school MARITAL STATUS: (CHECK ALL THAT APPLY)

2. PARISHIONER STATUS 175 Saint Joseph Drive Amherst, OH 44001 [p] (440) 988-4244 [f] (440) 988-5249 www.sjsamherst.org SAINT JOSEPH SCHOOL A Higher Standard SCHOOL OFFICE TUITION Please select one: ACTIVE PARISHIONER OF SAINT JOSEPH PARISH Membership: Registration is the first step to becoming an active and participating parishioner of Saint Joseph Parish. Being active includes 1) Will participate at Mass every Sunday and holyday of obligation. We will give evidence of our being present by using our Sunday Offertory envelopes every week, whether full or empty. 2)Participate in at least one ministry in our Parish, whether within the school itself or within the Parish at large. 3)Will regularly contribute financially to support our Parish according to the way we have been blessed. If we are not already tithing, we will work towards this goal. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE NON PARISHIONER / NON-ACTIVE PARISHIONER ENVELOPE NUMBER As a non-parishioner or a non-active parishioner of Saint Joseph Parish, I will support the school by teaching my child(ren) Christian values and the importance of belonging to a Christian community. I/We also agree to support Saint Joseph School through active participation with school programs, special events programs, and special school needs. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE CHURCH OR PARISH RELIGION Please return this completed form and the $75 non-refundable application fee for each student to be enrolled for the 2016-2017school year The difference between the published tuition and the amount awarded by ODE shall be paid by the parent.. (IMPORTANT: All blanks on all sides of this form must be filled in or application and registration fee will be returned.) COST Tuition cost per pupil is $4,500 for the 2016-17 school year. “EdChoice” / “EdChoice EXPANSION” SCHOLARSHIP PROGRAM The Educational Choice Scholarship (EdChoice) is a Government Program created to provide students from underperforming public schools the opportunity to attend participating private schools. EdChoice scholarships are awarded to those living in an underperforming school district. EdChoice Expansion scholarships are awarded to incoming kindergarten and first graders based on household income. You must apply for EdChoice separately. For more information, please visit: edchoice.ohio.govedchoice.ohio.gov I/We plan to apply for the EdChoice Scholarship / EdChoice Expansion and agree to pay the $75 non-refundable registration fee. CHECK # FOR OFFICE USE ONLY REGISTRATION FEE AMOUNT RECEIVED NOTES FEES TOTAL AMOUNT RECEIVED: All FEES ARE NON-REFUNDABLE CASHOTHER $75 EdChoice SCHOLARSHIP RENEWAL Students who are currently receiving an EdChoice Scholarship can renew the scholarship for the 2016-2017 school year as long as they meet the following requirements: They take all required state achievement tests for their grade level if they are in grades 3-8 and they take all parts of the Ohio Graduation Tests if they are in grade 10; They do not have more than 20 unexcused absences for the school year; and They do not move out of the school district in which they became eligible. Note: Certain restrictions may apply, please visit the EdChoice page on the Ohio Department of Education website or call them for more information. THE SCHOLARSHIP APPLICATION PERIOD FOR THE 2016-2017 SCHOOL YEAR BEGINS FEBRUARY 1, 2016. PLEASE SEE THE SCHOOL OFFICE FOR MORE INFO. EdChoice SCHOLARSHIP PROGRAM I/We pledge to fill out all necessary paperwork and show we live in a school district that supports the EdChoice Scholarship. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE CHURCH OR PARISH RELIGION EdChoice EXPANSION SCHOLARSHIP Please select one: PLEASE COMPLETE: If you plan to apply for EdChoice through the Ohio Department of Education, please complete the fields below. EdChoice SCHOLARSHIP RENEWAL EdChoice EXPANSION RENEWAL